Increase In Number Of Diagnoses Research Articles

Incidence of gynaecological cancer during the COVID-19 pandemic: A population-based study in the Netherlands

ObjectiveTo study the impact of the COVID-19 pandemic and consequent lockdown on the number of diagnoses of gynaecological malignancies in the Netherlands. MethodsWe performed a retrospective cohort study using data from the Netherlands Cancer Registry (NCR) on women of 18 years and older diagnosed with invasive endometrial, ovarian, cervical or vulvar cancer in the period 2017–2021. Analyses were stratified for age, socioeconomical status (SES) and region. ResultsThe incidence rate of gynaecological cancer was 67/100.000 (n = 4832) before (2017–2019) and 68/100.000 (n = 4833) during (2020) the COVID-19 pandemic. Comparing the number of diagnoses of the two periods for the four types of cancer separately showed no significant difference. During the first wave of COVID-19 (March-June 2020), a clear decrease in number of gynaecological cancer diagnoses was visible (20–34 %). Subsequently, large increases in number of diagnoses were visible (11–29 %). No significant differences in incidence were found between different age groups, SES and regions. In 2021 an increase of 5.9 % in number of diagnoses was seen. ConclusionIn the Netherlands, a clear drop in number of diagnoses was visible for all four types of gynaecological cancers during the first wave, with a subsequent increase in number of diagnoses in the second part of 2020 and in 2021. No differences between SES groups were found. This illustrates good organisation of and access to health care in the Netherlands.

128 Trends in Diseases of Vestibular Function - a Retrospective Study into the Diagnosis of Different Types of Vestibular Disorders in Admitted Hospital Patients in England 2014–2020

Abstract Aim The vestibular system is a sensory organ of the inner ear contributing towards balance, orientation, and coordination. Symptoms of vestibular dysfunction are a common presentation to hospitals in England. Method Using the NHS Digital website and accessing the Hospital Admitted Patient Care Activity datasets, we identified episodes of “Disorders of Vestibular Function”. This definition was further broken down into seven sub-types of different vestibular disorder. The data covers all NHS funded work in English hospitals resulting in admission. Using a 6-year period between 1st April 2014–31st March 2020 trends in number of admitted patients were recorded. Results There was an 84% increase in the number of patients admitted to hospital for diseases of vestibular function. From 6,473 admissions in 2014, to 11,960 in 2020. The largest increase was seen in patients admitted with Benign Paroxysmal Positional Vertigo (BPPV) with an increase of 4,154 admissions, equivalent to a 126% rise. The trend was progressive and consistent year on year. All other conditions such as vestibular neuritis, other peripheral vertigo and unspecified vestibular disorders increased, however diagnoses of Ménière's disease fell 2%. Patients with BPPV had the highest average age upon diagnosis. Conclusions There is a clear need to investigate the drivers of the increase in number of diagnoses and admissions. Hypothesised reasons include an ageing population, improved diagnostics, or coding errors. It may also be a result of increasing hospital attendances and a decrease in see and treat of patients with BPPV in A&E.

Clinical and pathogenetic features of the development of non-communicable diseases depending on the degree of comorbidity, the stage of cardiovascular continum

The article is devoted to the clinical study of the clinical and pathogenetic features of the development of non-communicable diseases, depending on the degree of comorbidity and the stage of the cardiovascular continuum.The aim was to determine the clinical and pathogenetic features of the development of non-communicable diseases, depending on the degree of comorbidity and the stage of the cardiovascular continuum, and to improve the methodology of patient management, taking them into account accordingly.Material and methods. 439 people were examined in an open, non-randomized, controlled study. 253 people were sick with non-communicable diseases (main group) and 186 people were functionally healthy respondents (control group). All participants in the study underwent a retrospective assessment of medical records, with the calculation of the history of diseases, assessment of the degree of comorbidity and determination of the stage of the cardiovascular continuum.Results. It was found that the principle of diagnostic monism is not an adequate methodological approach for all patients with non-communicable diseases since there were no people with one verified diagnosis among them. A significant increase in the average number of diagnoses was noted between the subgroups of the control group and the main group. An increase in the level of comorbidity in terms of CIRS, Charlson index, SCORE was noted between the control subgroups and subgroup 1 of the main group (p <0.0001), between subgroup 1 and other subgroups of the main group (p <0.0001), between subgroup 2 and subgroups 3 and 4 (p <0.0001).
 Conclusions. Comorbidity is a characteristic feature of non-communicable diseases, a manifestation of the systemic progression of metabolic disorders. It significantly increases with the age of patients and it has a significant increase in the number of diagnoses and the risk of death from cardiovascular diseases in the development of the cardiovascular continuum with the maximum number of diagnoses at the stage of its complication. The cardiovascular continuum plays a key role in increasing comorbidity, the risk of death. It determines the prognosis and is an integral part of the overall continuum in non-communicable diseases and has a comorbid relationship with diseases of the upper gastrointestinal tract as the basis of the metabolic pattern. Comorbidity should be taken into account in the management of patients as a manifestation of the systemic progression of metabolic disorders and the general continuum in non-communicable diseases.

Effect of an awareness campaign on the diagnosis and clinical impact of primary immunodeficiency

Background and objectivesPredominantly antibody deficiencies are the most prevalent primary immunodeficiency (PID) in adults. These are rare diseases difficult to diagnose. Therefore, they are diagnosed late. This study aims to evaluate whether an awareness campaign of PIDs among physicians is associated with an increase in number of diagnoses, a reduction in diagnostic delay and diagnosis at earlier stages. Patients and methodsA single centre, interventional, quasi-experimental study was designed that included 2 periods, period 1 pre-intervention (1986–2008) and period 2 post-intervention (2009–2018). A descriptive comparative study of variables was carried out in both periods. Results116 patients were included [27 (23.3%) in period 1 and 89 (76.7%) in period 2]. The incidence rate increased significantly (0.204 and 1.236/100,000habs./year; p<0.05), the diagnosis delay tended to be lower (4 vs. 3.73 years). The reasons for diagnostic suspicion were diverse and the burden disease at diagnosis (expressed by bronchiectasis, altered spirometry, ability to generate antibodies by thymus-independent mechanism and need for substitute treatment) tended to decrease in period 2. ConclusionsGiven the potentially serious complications of patients with late diagnosis of PIDs, it is necessary to create specialised multidisciplinary units, to unify assistance protocols and to design interventions to increase the knowledge of these entities.

Efecto de una campaña de concienciación en el diagnóstico e impacto clínico de la inmunodeficiencia primaria

Background and objectivesPredominantly antibody deficiencies are the most prevalent primary immunodeficiency (PID) in adults. These are rare diseases difficult to diagnose. Therefore, they are diagnosed late. This study aims to evaluate whether an awareness campaign of PIDs among physicians is associated with an increase in number of diagnoses, a reduction in diagnostic delay and diagnosis at earlier stages. Patients and methodsA single centre, interventional, quasi-experimental study was designed that included 2 periods, period 1 pre-intervention (1986-2008) and period 2 post-intervention (2009-2018). A descriptive comparative study of variables was carried out in both periods. Results116 patients were included [27 (23.3%) in period 1 and 89 (76.7%) in period 2]. The incidence rate increased significantly (0.204 and 1.236/100,000habs./year; P < 0.05), the diagnosis delay tended to be lower (4 vs. 3.73 years). The reasons for diagnostic suspicion were diverse and the burden disease at diagnosis (expressed by bronchiectasis, altered spirometry, ability to generate antibodies by thymus-independent mechanism and need for substitute treatment) tended to decrease in period 2. ConclusionsGiven the potentially serious complications of patients with late diagnosis of PIDs, it is necessary to create specialized multidisciplinary units, to unify assistance protocols and to design interventions to increase the knowledge of these entities.

370 Changing incidence and presentation of merkel cell carcinoma in a retrospective single-center case series

Merkel cell carcinoma (MCC) is an uncommon aggressive cutaneous neuroendocrine tumor with high mortality. The purpose of this study is to describe the pathologic characteristics and clinical correlates of MCC using a retrospective chart review of 117 cases in a single tertiary center pathology database from 1997 to 2015. MCC occurred mostly in the elderly (median age 76 years, range 22-99 years) and more often in males (M:F 1.21:1). MCC was most commonly located on the head and neck (n=59, 50%) followed by the upper extremities (n=16, 14%), lower extremities (n=13, 11%), and trunk (n=7, 6%). Males were more likely to have the tumor located on the trunk (relative risk [RR] 1.84, 95% confidence interval [CI] 1.26-2.68, p<0.01) and to also have a history of cutaneous squamous cell carcinoma (SCC) (RR 1.44, CI 1.04-1.99, p=0.03) when compared with females. A total of 55 cases (47%) exhibited metastasis with 75% (n=41) of these to the lymph nodes and 26% (n=14) to distant locations. MCC recurred in 17 cases (15%), with a median of 14 months to recurrence. Some common pathological characteristics of the primary skin tumor include lymphovascular invasion (n=21, 18%), necrosis (n=16, 14%), ulceration (n=10, 9%), and SCC collision (n=5, 3%) but these features did not correlate with outcome. Overall, there has been an increase in number of diagnoses per year from 1997 to 2015, with 2.3 times more cases diagnosed in the last 3 years of the study period than in the first 3 years. Cases diagnosed after 2006 were more likely to occur in younger patients, less than 76 years of age (RR 0.43, CI 0.24-0.78, p=0.01) and to occur in the upper extremities (RR 1.34, CI 0.996-1.80, p=0.05). Prior to 2006, the median age was 81 years, while after 2006, the median age decreased to 75 years. This retrospective case series elucidates MCC epidemiologic and pathologic characteristics, including how incidence, age at diagnosis, and location have changed over the course of the study.

Unplanned hospital admissions in senior cancer patients receiving chemotherapy: Preliminary evaluation of the use of pre-chemotherapy assessment tools in daily care

8th and 9th Revisions (ICD-8 and 9) of the International Classification of Diseases and as C61 in the 10th Revision (ICD-10). Breast cancer was coded as 174 (ICD-8 and 9) and C50 (ICD-10), colorectal cancer as 153 and 154 (ICD-8 and 9) and C18–C21 (ICD 10), and lung cancer as 162 (ICD-8 and 9) and C33–C34 (ICD 10). Data was analysed according to 5 year age bands: 65–69, 70–74, 75–79, 80–84 and 85 and over, and these are presented separately for each sex and tumour. Crude ageand European standardised incidence rates were also calculated. Results: For all 4 cancers with the exception of lung cancer in men, there were increases in both the incidence rates and number of cancer registrations. Number of registrations of prostate cancer increased by 433%, breast cancer 143%, colorectal cancer 137% (males) and 61% (females) and lung cancer 278% (females). The increase in both incidence rates and number of cancer registrations were especially seen in the 80 and over group in breast, colorectal and lung cancer. Conclusions: The increase in number of diagnoses from 1971 to 2009 for these four cancers represents an additional 52,000 cancers per year in patients aged 65 and over. This is likely to increase further with the ageing of the population.